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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371465
Report Date: 08/14/2025
Date Signed: 08/14/2025 03:57:34 PM

Document Has Been Signed on 08/14/2025 03:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SMILES MONTESSORI CHILDCAREFACILITY NUMBER:
304371465
ADMINISTRATOR/
DIRECTOR:		AHN, SUNG JAFACILITY TYPE:
830
ADDRESS:2261 NORTH ORANGE OLIVE ROADTELEPHONE:
(714) 283-2857
CITY:ORANGESTATE: CAZIP CODE:
92865
CAPACITY: 20TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
08/14/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee/Director, Sung Ja AhnTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 8/14/25, Licensing Program Analysts (LPAs) Jung and Lucero conducted an unannounced Case Management – Legal/Non-Compliance inspection. At approximately 9:00AM, LPAs met with Licensee/Director, Sung Ja Ahn, and was led on a tour of the facility. There were six (6) infant children and three (3) infant staff present. The facility was operating within teacher-child ratios and licensed capacity.

Facility Personnel Report Summary review indicated all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Korean translation was provided by LPA Jung during the visit. LPAs conducted record reviews for staff and children.

Three (3) staff's files were reviewed and found to be incomplete. Staff 2 (S2) was missing their immunization record and health screening; see LIC 809D for deficiencies.

Five (5) children's files were reviewed and found to be incomplete. Child 3 (C3) and Child 4 (C4) were missing Admission Agreements; see LIC 809D for deficiency. Child 5 (C5) was missing their LIC 9227 Individual Infant Sleeping Plan; see LIC 809D for deficiency.

Facility did not have a current facility roster; see LIC 809D for deficiency.

A Notice of Site Visit was given and must remain posted for 30 days. Report was reviewed with the Licensee/Director, Sung Ja Ahn.
NAME OF LICENSING PROGRAM MANAGER: Nguyen K Tran
NAME OF LICENSING PROGRAM ANALYST: Soo Jin Jung
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/14/2025 03:57 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 08/14/2025 at 02:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
HSC
1596.7995

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1596.7995 Employees or volunteers at day care center; immunization requirements; records; exemptions: (a) (1)... a person shall not be employed... at a day care center if he or she has not been immunized against influenza, pertussis, and measles... This requirement was not met as evidenced by:
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Licensee stated that they will email a copy of Staff 2 immunization record showing tuberculosis, measles, and flu to LPA by due date.
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Based on record review, the licensee did not comply with the section cited above in that, Staff 2 did not have their immunization record on file, which poses a potential health, safety, or personal rights risk to persons in care.
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Type B
08/22/2025
Section Cited
CCR101219(a)

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101219(a) Admission Agreements: The licensee and the child's authorized representative shall...complete a ...written admission agreement for the child....shall be maintained at the child care center and shall be available for review. This requirement was not met as evidenced by:
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Licensee stated that they will email a copy of C3 and C4 admission agreement to LPA by due date.
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Based on record review, the licensee did not comply with the section cited above in that, Child 3 (C3) and Child 4 (C4) did not have admission agreements in their file, which poses a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Soo Jin Jung
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2025 03:57 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 08/14/2025 at 02:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
CCR
101419.2(b)(2)

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101419.2(b)(2) Infant Needs and Services Plan: Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)]. This requirement was not met as evidenced by:
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Licensee stated that they will email a copy of C5 LIC 9227 to LPA by due date.
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Based on record review, the licensee did not comply with the section cited above in that,Child 5 (C5) did not have a completed LIC 9227 on file, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/22/2025
Section Cited
HSC1596.841

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1596.841 Current roster of children provided care in facility required: Each child day care facility shall maintain a current roster of children who are provided care in the facility... This requirement was not met as evidenced by:
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Licensee stated that they will email a copy of the current facility roster to LPA by due date.
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in that, licensee did not have a current roster of children enrolled, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Soo Jin Jung
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2025 03:57 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 08/14/2025 at 03:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: SMILES MONTESSORI CHILDCARE
FACILITY NUMBER: 304371465

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
CCR
101217(a)(11)

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101217(a)(11) Personnel Records: A health screening as specified in Section 101216(g). This requirement was not met as evidenced by:
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Licensee stated that they will email S2's health screening to LPA by due date.
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Based on record review, the licensee did not comply with the section cited above in that, Staff 2 (S2) did not have a health screening on file, which poses a potential health, safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nguyen K Tran
NAME OF LICENSING PROGRAM MANAGER:
Soo Jin Jung
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2025


LIC809 (FAS) - (06/04)
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